Association of the affordable care act Medicaid expansions with postpartum contraceptive use and early postpartum pregnancy

Eliason, Erica L.; Spishak-Thomas, Amanda; Steenland, Maria W.

doi:10.1016/j.contraception.2022.02.012

Cited by 16 publications

(23 citation statements)

References 21 publications

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“…For the full report, our electronic searches yielded 25 973 citations (Figure). We screened 589 full-text articles, of which 28 studies, reported in 29 articles, were eligible for the current systematic review.…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, 2 studies evaluated the impact of policy changes that made insurance coverage less comprehensive: 1 study in North Carolina that evaluated a policy reducing reimbursement rates for maternity care coordination by 19% and 1 study in Oregon that evaluated a policy requiring undocumented immigrants and legal immigrants within 5 years of immigration with Emergency Medicaid who wanted sterilization following vaginal delivery to pay for it . Finally, 9 studies compared outcomes in various insurance expansion and nonexpansion (or contraction) states …”

Section: Resultsmentioning

confidence: 99%

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Health Insurance Coverage and Postpartum Outcomes in the US

Saldanha,

Adam,

Kanaan

et al. 2023

JAMA Netw Open

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ImportanceApproximately half of postpartum individuals in the US do not receive any routine postpartum health care. Currently, federal Medicaid coverage for pregnant individuals lapses after the last day of the month in which the 60th postpartum day occurs, which limits longer-term postpartum care.ObjectiveTo assess whether health insurance coverage extension or improvements in access to health care are associated with postpartum health care utilization and maternal outcomes within 1 year post partum.Evidence ReviewMedline, Embase, CENTRAL, CINAHL, and ClinicalTrials.gov were searched for US-based studies from inception to November 16, 2022. The reference lists of relevant systematic reviews were scanned for potentially eligible studies. Risk of bias was assessed using questions from the Cochrane Risk of Bias tool and the Risk of Bias in Nonrandomized Studies of Interventions tool. Strength of evidence (SoE) was assessed using the Agency for Healthcare Research and Quality Methods Guide.FindingsA total of 25 973 citations were screened and 28 mostly moderate-risk-of-bias nonrandomized studies were included (3 423 781 participants) that addressed insurance type (4 studies), policy changes that made insurance more comprehensive (13 studies), policy changes that made insurance less comprehensive (2 studies), and Medicaid expansion (9 studies). Findings with moderate SoE suggested that more comprehensive association was likely associated with greater attendance at postpartum visits. Findings with low SoE indicated a possible association between more comprehensive insurance and fewer preventable readmissions and emergency department visits.Conclusions and RelevanceThe findings of this systematic review suggest that evidence evaluating insurance coverage and postpartum visit attendance and unplanned care utilization is, at best, of moderate SoE. Future research should evaluate clinical outcomes associated with more comprehensive insurance coverage.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Health Insurance Coverage and Postpartum Outcomes in the US

Saldanha,

Adam,

Kanaan

et al. 2023

JAMA Netw Open

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“…For example, insurance status has frequently been noted as a barrier to contraception, though this has been partially mitigated by recent expansions of Medicaid. [10][11][12][13] However, racial and ethnic disparities to access to postpartum contraception remain, even among those similarly covered under Medicaid insurance. 14 A thorough review of the multi-level factors and barriers impacting postpartum contraception is outside the scope of this manuscript.…”

Section: Introductionmentioning

confidence: 99%

Shared Decision-Making: The Way Forward for Postpartum Contraceptive Counseling

Bullington¹,

Sata²,

Arora³

2022

OAJC

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There are multi-level barriers that impact uptake of postpartum contraception and result in disparities, including clinical barriers such as provider bias. Fortunately, clinicians have direct control over their contraceptive counseling practices, and thus reducing structural barriers is actionable through high quality contraceptive counseling that equips patients with the knowledge and guidance they need to fulfill their reproductive desires. Yet, many commonly employed contraceptive counseling strategies, like One Key Question and WHO tiered contraceptive counseling, are not patient-driven, do not account for the important nuances of contraceptive choices, and are not focused specifically on the postpartum period. Given the history of eugenics and reproductive coercion in the US, supporting patient through their contraceptive decision-making process is especially vital. Additionally, contraceptive preferences vary based on patient-level factors and fluctuate over time and counseling should account for such differences. Shared contraceptive decision-making occurs when patients provide input on their values, desires, and preferences and clinicians share medical knowledge and evidence-based information without judgement. This approach is considered the most ethically sound form of counseling, as it maximizes patient autonomy. Shared decision-making also has clinical benefits, including increased patient satisfaction. In sum, shared contraceptive decision-making should be universally adopted to promote ethical, high-quality care and reproductive autonomy.

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“…Extensions in postpartum Medicaid also led to increased availability of substance use disorder resources [5,16,19]. Postpartum Medicaid extension improves access to contraceptive services, translating into decreased rates of unintended pregnancy and short interpregnancy intervals, which has important implications for maternal interpregnancy health optimization and preterm birth prevention [19,[23][24][25][26]. Logistically, continuous insurance coverage postpartum enables patients to utilize contraceptive methods-such as intrauterine devices and implants-that often require more than one visit.…”

mentioning

confidence: 99%

“…Logistically, continuous insurance coverage postpartum enables patients to utilize contraceptive methods-such as intrauterine devices and implants-that often require more than one visit. As a result, Medicaid expansion has been associated with an increase in postpartum long-acting reversible contracep-tive use and a decrease in short-acting contraceptive use [25]. The increased use of high-efficacy contraceptive methods leads to fewer unintended pregnancies and also lengthens interpregnancy interval, improving maternal and infant outcomes with subsequent pregnancies.…”

mentioning

confidence: 99%